1. Field of the Invention
The present invention relates generally to a full-thickness resection device (FTRD) for performing localized resections of lesions in tubular organs, particularly the colon. The present invention has particular application to transanal and transoral surgical procedures, although it is not limited thereto.
2. Description of the Related Art
A resection procedure involves excising a portion of an organ, approximating the surrounding tissue together to close up the hole created by the excision, and removing the excess tissue. Various conventional devices and procedures are available for resectioning lesions in tubular organs.
For example, several known resection devices and procedures require at least one incision in an area near the portion of the organ to be excised for access to the lesion or treatment site (because, for example, the resectioning device may lack steering and/or viewing capabilities). Thus, the incision is required to allow the physician to access the organ section to be excised and guide the device to that section. Alternatively, when the organ section to be excised is beyond the reach of the surgical device, or the surgical device is not flexible enough to wind through the organ to the site to be excised, an incision will be required to position the device for the procedure. Of course, these incisions are painful and may involve a partial or entire loss of mobility while recuperating from the incision, in addition to recovering from the tubular resectioning procedure itself. In addition, the time required to recover from such a procedure is often longer than for procedures which do not require incisions.
One type of conventional resection procedure utilizes a circular stapling instrument in which a tubular section of a tubular organ is excised, resulting in the tubular organ being separated into a first segment and a second segment. The end sections of the first and second segments are then individually tied in a purse-string fashion, approximated, stapled, and the xe2x80x9cpurse-stringedxe2x80x9d end sections are then cut off. In this full circle resectioning procedure, at least one separate invasive incision must be made near the section to be excised in order to cut and individually tie the separate end sections of the organ. Also, a separate incision is necessary to place one part of the resectioning device in the first segment and a corresponding second part of the device in the second segment so that the device can then bring the first and second segments together to re-attach the organ sections back together. A first of these separate parts may generally include a staple firing mechanism while the second part includes an anvil for forming the staples. Thus, this type of resectioning procedure involves the drawbacks mentioned above in regard to procedures requiring invasive incisions. In addition, the separation of the organ into two segments creates the risk of spillage of non-sterile bowel contents into the sterile body cavity, which can cause severe infection and possibly death.
An alternative resectioning device includes a stapling and cutting assembly on a shaft which can be bent or formed into a desired shape and then inserted into a patient""s body cavity. Once the shaft has been bent into the desired shape, the rigidity of the shaft ensures that that shape is maintained throughout the operation. This arrangement limits the effective operating range of the device as the bending of the shaft into the desired shape before insertion and the rigidity of the shaft once bent require the physician to ascertain the location of the organ section to be removed before insertion, and deform the shaft accordingly. Furthermore, the rigidity of the shaft makes it difficult to reach remote areas in the organxe2x80x94particularly those areas which must be reached by a winding and/or circuitous route (e.g., sigmoid colon). Thus, an incision may be required near the organ section to be excised in order to position the device at the organ section to be excised.
Currently such FTRD""s incorporate standard endoscopes available from various manufacturers. These standard endoscopes are circular in shape, and while a circular shape is desirable in many conventional applications where the endoscope is used independently, with FTRD""s, a circular endoscope, for example, takes up significant space in the body lumen. This can result in a sample having a smaller size than desired. A circular endoscope also may not have sufficient flexibility to bend to a desired location.
In accordance with the invention, a proximal housing for a full-thickness resection device (FTRD) is provided with a plurality of chambers through which fasteners are introduced into a portion of tissue to be resected. The proximal housing has a noncircular cut-out opposite the plurality of chambers to receive a noncircular endoscope. The proximal housing also is provided with a resection cavity into which the tissue to be resected is to be received. In addition, shaft openings are provided through which mounting shafts may be inserted.
According to another aspect of the invention, the plurality of chambers is configured so as to provide a substantially elliptical fastener pattern.
According to yet another aspect of the invention, the fasteners used are staples.
According to another aspect of the invention, a noncircular endoscope is also disclosed that is substantially the same shape as the cut-out for insertion into the cut-out whereby the endoscope has passages to house the functions of remote viewing, lighting, insufflation and irrigation.
According to another aspect of the invention, the noncircular endoscope is elliptical in shape.
Additional objects and advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. Both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed.